Aesthetic Flat Closure 2026 Research University of Denver
We were so excited when Dr. Trisha Raque reached out to share the research she and her team at the University of Denver did around the decision to go flat after a double mastectomy. Flatties in the YSC community all have different reasons going flat was right for them, but we often hear they don’t all feel supported in that decision by their healthcare provider team. That came through in the research, too.
If you're facing this decision yourself — or supporting someone who is — we hope this gives you something you didn't have before: the full range of what "choice" can actually look like.
When facing a double mastectomy, breast cancer survivors have to make hard decisions about what they want their bodies to look like afterward. During that decision-making window, it matters that survivors know all of their options — including Aesthetic Flat Closure (AFC) — so they can choose what's right for their own bodies.
Too often, though, survivors tell us that providers assumed they'd want implant or tissue-based reconstruction, and never mentioned flat as a choice at all.
Together with a research team from the University of Denver, I've been analyzing interviews with 39 breast cancer survivors who chose to go flat after a double mastectomy. 18 were diagnosed before age 45. Our findings on this 18 younger group were recently published in Psycho-Oncology. Here, I want to share some of what we learned, in their words as much as possible.
AFC is considered the gold standard for "going flat.” It’s the surgical work that smooths and evens the chest wall after mastectomy, so the result is flat, clean, and symmetric.
The young survivors in our study chose it because they wanted the fastest recovery, wanted to avoid future surgeries and complications, and believed it was the safest, most natural option for them. As one survivor told us:
"I'm a natural girly. So I don't like the idea of having foreign objects in my body regardless... Getting my life back as soon as possible. I was done being a human pin cushion. I didn't want to go surgery after surgery after surgery. I wanted to go back to being a healthy happy mom for my two-year-old."
Whose Beauty Standards?
Survivors in our study questioned why — and for whom — they were undergoing reconstruction at all. Was it something they actually wanted, or just what they assumed society expected of them?
Many pushed back on beauty standards that overvalue breasts in the first place. As one participant put it, "I don't want to live my life based off of what I think other people think… My decision is…my body is my choice. Everyone should have their own choice.”
For many, going flat was a way to reclaim that choice.
The “Appointment Olympics”
Several participants also felt their providers glossed over just how demanding reconstruction can be: how many surgeries, how long a recovery, how much it might shape the years ahead. For younger participants especially, who'll be living with these decisions for decades, that gap mattered.
One person described it like this:
"I was just under the impression that we were going to take [breast tissue] out, put [the implant] in, right? You know, it's a party. [But] the expansion process sounds lengthy. I call this whole thing the 'Appointment Olympics.' So more 'Appointment Olympics' for months and months and months...Then [the surgeon] talks about, 'You're young, so every 10 years or so, we'll have to go in probably, and adjust, twist, move it [implant] around, redo it, put a new one in there.' He said that like we were talking about going to the mall and picking out new bras. 'We have to tweak it. We might replace it with something new when something new comes out.' I'm like, 'what are we talking about? We're not talking about an SD card, an iPhone. We're talking about my boobs. We are talking about surgery, right?'...So I was like, am I going to do all this work for boobs?"
Breasts ≠ Woman
Those who chose to go flat were clear: their breasts don't define them — not as women, mothers, partners, or caregivers. And when we asked how often other people noticed or commented on their flatness, the answer was reassuring:
"It happens a lot less than you think. There's not a lot of people out there policing or questioning things. And there's plenty of ways to dress that will make you look more feminine.”
After AFC, survivors found their own ways to express their femininity through clothing, hair, jewelry, makeup, or prosthetics, entirely on their own terms, if that’s what they wanted.
Some pointed to the trans liberation movement as a model for this: that "woman" is self-defined, and doesn't have to look one particular way.
They also noted that the rise of gender-affirming surgery has sharpened surgeons' skills and their comfort supporting patients who want options outside the default.
When a Decision Doesn’t Feel Like Ours
But getting to AFC wasn't always straightforward. Most of the younger participants in our study encountered surgeons who initially questioned — or simply didn't respect — their decision.
Many providers assumed reconstruction was the goal and never raised AFC unless asked directly. "When it came to breast cancer, there was never any information on going flat," one person told us. "I didn't even know that it was a thing. I thought that reconstruction was the only option.”
Three participants described telling their surgeons clearly that they wanted to go flat only to wake up with "dog ears" left behind, possibly because the surgeon assumed they'd change their mind later and want reconstruction after all. This completely removed the decision-making power from them about their own bodies.
One of them described the experience starkly:
"I honestly felt like I had been assaulted. I mean, I was unable to protect myself under anesthesia. I said, 'No.' Nobody listened to my 'no.' Nobody stopped him [surgeon] from doing it. I was very clear about saying no. And nobody, nobody put a stop to it. Nobody stepped in. So I felt very, I felt like it was an assault or battery against me.”
Time and again, participants had to research AFC themselves and bring that information back to their own care teams. Self-advocacy wasn't optional for them. It was the only way through. As one participant put it, "the only reason that happened is because I was an advocate for myself. I was being pushed around the medical system like no other.”
Real Tips from Real People
When asked how they were able to get the AFC surgery they wanted despite all the roadblocks, they shared what got them through.
Trusting themselves
Reflecting on what their breasts mean to them and to the people whose opinions actually matter to them
Coming to appointments with specific questions: recovery timelines, possible complications, long-term effects, how treatments like radiation might affect their options
Using resources from organizations like Not Putting On a Shirt
Bringing surgeons photos of the result they wanted
One study participant told us plainly what they wanted for the provider community going forward: "I want medical providers to know exactly what flat closure is, aesthetic flat closure is, and listen, listen to what we say when we say we need what we want.”
Post written by Dr. Trisha Raque, Professor, Department of Counseling Psychology, University of Denver, with gratitude to the breast cancer survivors who participated in this study.
